MEDICARE: SAVANNAH LOMAX REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN297226	GA

General Provider Information

NPI Number	:	1386215721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH LOMAX REGISTERED NURSE

Provider Business Mailing Address
First Line	:	1202 GROVE TRAIL PASS
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-8008
Country	:	US
Telephone Number	:	407-307-9653
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 GROVE TRAIL PASS
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-8008
Country	:	US
Telephone Number	:	407-307-9653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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